- May be covered under Medical Benefit.
- Diabetes Type 2: Long Acting Insulin + Combo:
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Supporting Documentation Requirements: 2 of Chart Notes;Medication History
- Quantity Limit: 1 spacer per prescription
- Quantity Limit: limit maximum 1 GM PER 30 day(s)
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